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13: MITRAL REGURGITATION

Natalie V. Wessel, DO, MPH; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Left atrial overload

  • Mitral valve regurgitation

  • Mitral valve insufficiency

ICD-9-CM CODES

  • 394.1 Rheumatic mitral insufficiency

  • 424.0 Mitral valve disorders

  • 746.6 Congenital mitral insufficiency

ICD-10-CM CODES

  • I05.1 Rheumatic mitral insufficiency

  • I34.0 Nonrheumatic mitral (valve) insufficiency

  • Q23.3 Congenital mitral insufficiency

PREFERRED PRACTICE PATTERN

  • 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure1

PATIENT PRESENTATION

A 65-year-old female, with a history of mitral valve prolapse (MVP) and an irregular heartbeat, presents with shortness of breath on walking. Vitals are: Pulse: 92, Respirations: 24, Blood Pressure: 132/80, and SpO2% of 97%. On physical examination there are bounding arterial pulses bilaterally and a leftward displacement of the apical impulse. Cardiac auscultation reveals a holosystolic murmur over the apex of the heart. EKG readings are nonspecific and the echocardiogram shows an enlarged left ventricle, enlarged left atria, and a regurgitant volume into the left atria of 65 mL.

KEY FEATURES

Description

  • Mitral valve does not close properly during systolic contraction of left ventricle.

    • Causes backflow and fluid overload in left atrium.

  • Fluid overload in left atrium can lead to weakening of left atrial wall.

  • Fluid overload in left atrium can also cause pooling and clotting in left atrium.

  • Mitral regurgitation (MR) is the most common type of valvular heart disease.

Essentials of Diagnosis

  • Stethoscope for auscultation systolic murmur in mitral position

  • EKG/ECG2

  • Echocardiogram

FIGURE 13-1

Continuous wave tracing of mitral regurgitation with calculation of dP/dt (apical transducer position). The time period between velocities of 1 and 3 m/s is 0.07 second, the calculated dP/dt is approximately 460 mm Hg/s. (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart, 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Patients with significant MR can show signs and symptoms of congestive heart failure.

  • Strenuous activity should be limited for symptomatic MR.

  • Signs and symptoms should be monitored.

  • Can lead to sudden cardiac death, arrhythmias, embolic events, and coronary disease.

  • Patients can develop bacterial endocarditis.

  • Valve problems can develop 5 to 10 years after rheumatic fever.

  • Ischemic heart disease, rheumatic fever, and Marfan syndrome are also associated with MR.

Demographics

  • MR can be congenital, present from birth.

  • More common in women and with advanced age.

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Symptoms depend on the degree of valvular dysfunction

  • Mild-to-moderate regurgitation generally does not cause symptoms

  • Deviation of heartbeat or point of maximal impulse (PMI)

  • Cardiovascular collapse or shock

  • Audible systolic murmur at ...

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